Gender Influence on In-hospital Outcomes of Primary Percutaneous Coronary Intervention

Bangladesh Heart Journal Pub Date : 2022-06-20 DOI:10.3329/bhj.v37i1.60103

Subas Caandro Datta, M. Azam, J. Jahan, T. Chowdhury, M. Mamunuzzaman, Md Sazzad Masum, SM Nazmul Huda, Md. Shamim Aktar

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Abstract

Background: Acute myocardial infarction (AMI) is one of the leading cause death and disability all over the world. But, there is a lack of data about the gender influence on in-hospital outcomes of primary percutaneous coronary intervention (pPCI) among Bangladeshi patients. This study was aimed to evaluate the clinical and angiographic differences and to compare their in hospital outcomes of pPCI between male and female patients. Objective: To evaluate the gender influence on in-hospital outcome of primary PCI. Methods: This was a prospective observational study of 90 patients with ST elevation myocardial infarction ( STEMI ) treated with pPCI in the Department of Cardiology, NICVD, Dhaka, Bangladesh from April 2019 to March 2020, followed from admission until hospital discharge or death. The patients were divided equally into two groups, group ‘! (female) and group a! (male). Result : A significant difference was observed for age (61.8±10.9vs.56.5±10.7 years; p=0.02), hypertension (66.7% vs. 42.2%; p=0.02), diabetes (68.9% vs. 44.4%; p=0.01), smoking (0.0% vs. 68.9%; p<0.001), obesity (BMI- 28.3±3.8 vs. 26.5±3.9; p=0.02), troponin I (14.89±20.48 vs. 8.25±7.92; p=0.04) and pain-to-door time (281.90±88.70 vs. 240.33±80.81 minutes; p=0.04). Female had angiographically greater frequency of multivessel disease and similar distribution of infarct related artery in relation to male. The success of the procedure was similar (91.1% vs. 97.8%; p=0.18). Overall, female experienced greater incidence of in-hospital adverse events in comparison to male (28.8% vs. 13.3%; p=0.03) and significantly higher rates of severe bleeding (11.1% vs.2.2%; p=0.03) and vascular access site complications (15.6% vs. 4.4%; p=0.04). Major adverse cardiac events (MACE) were higher among females in comparison to males (11.1% vs. 6.7%; p=0.45). Females experienced significantly higher rates of short-term net adverse clinical events (NACE) than males (20.0% vs. 8.8%; p=0.04). Female sex [odds ratio (OR) 1.94], age e”60 years (OR 1.59) and diabetes (OR 2.75) were identified as independent predictors of adverse in-hospital outcomes among STEMI patients undergoing pPCI. Conclusion: Female sex presented with significantly more risk factors and experienced more in-hospital adverse outcomes than male in STEMI patients undergoing pPCI. They had significantly higher rates of NACE, largely driven by increased rate of major bleeding. Female sex was an independent predictor for the development of in-hospital adverse outcomes in STEMI patients undergoing pPCI. Bangladesh Heart Journal 2022; 37(1): 40-51

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性别对初次经皮冠状动脉介入治疗住院结果的影响

背景:急性心肌梗死(AMI)是世界范围内导致死亡和残疾的主要原因之一。但是，在孟加拉国患者中，缺乏关于性别对原发性经皮冠状动脉介入治疗(pPCI)住院结果影响的数据。本研究旨在评估临床和血管造影差异，并比较男性和女性患者pPCI的住院结果。目的:探讨性别对初次PCI住院疗效的影响。方法:这是一项前瞻性观察研究，对2019年4月至2020年3月在孟加拉国达卡NICVD心内科接受pPCI治疗的90例ST段抬高型心肌梗死(STEMI)患者进行了随访，从入院到出院或死亡。将患者平均分为两组，第1组;(女)和a组!(男)。结果:年龄(61.8±10.9vs.56.5±10.7)差异有统计学意义;P =0.02)，高血压(66.7% vs. 42.2%;P =0.02)，糖尿病(68.9% vs. 44.4%;P =0.01)，吸烟(0.0% vs. 68.9%;p<0.001)，肥胖(BMI- 28.3±3.8 vs. 26.5±3.9;p=0.02)，肌钙蛋白I(14.89±20.48∶8.25±7.92;P =0.04)、痛至门时间(281.90±88.70 vs 240.33±80.81 min);p = 0.04)。女性血管造影显示多血管病变的频率更高，梗死相关动脉的分布与男性相似。手术成功率相似(91.1% vs. 97.8%;p = 0.18)。总体而言，女性的院内不良事件发生率高于男性(28.8% vs. 13.3%;P =0.03)，严重出血发生率显著高于对照组(11.1% vs.2.2%;P =0.03)和血管通路并发症(15.6% vs. 4.4%;p = 0.04)。主要心脏不良事件(MACE)在女性中高于男性(11.1% vs. 6.7%;p = 0.45)。女性的短期净临床不良事件(NACE)发生率明显高于男性(20.0% vs 8.8%;p = 0.04)。女性[比值比(OR) 1.94]、年龄(OR) 60岁(OR 1.59)和糖尿病(OR 2.75)被确定为STEMI患者接受pPCI后不良住院结局的独立预测因素。结论:在接受pPCI的STEMI患者中，女性比男性出现更多的危险因素和更多的院内不良结局。他们有明显更高的NACE率，主要是由于大出血率的增加。女性是接受pPCI的STEMI患者发生院内不良结局的独立预测因子。孟加拉国心脏杂志2022;37 (1): 40-51

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Bangladesh Heart Journal

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